Comprehensive Anaemia Profile in Ulcerative Colitis Patients with Varying Disease Severities: A Cross-sectional Study

Abstract

Introduction: Anaemia is the most common Extraintestinal Manifestation (EIM) associated with Ulcerative Colitis (UC) and has been linked to increased mortality in UC patients, with iron deficiency having the most pronounced effect. Moreover, iron deficiency in UC can occur with or without anaemia. Aim: To assess anaemia and iron deficiency, with or without anaemia, in UC patients. Materials and Methods: The present cross-sectional study was conducted in the Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from August 2020 to December 2021. Study included 75 patients with UC and varying levels of disease activity. A complete haemogram, Red Blood Cell (RBC) indices, and serum iron studies {serum iron levels, Total Iron Binding Capacity (TIBC), Transferrin Saturation (TfS), and serum ferritin} were conducted. Patients were classified as having Iron Deficiency Anaemia (IDA), Anaemia of Chronic Disease (ACD), or mixed anaemia based on the results of the iron studies. Disease activity was assessed using the Mayo score. Patients were divided into group I (mild disease activity) and group II (moderate to severe disease activity). Haemoglobin (Hb), RBC indices and iron levels were compared between the two groups. Independent t-tests and Chi-square tests were employed for statistical analysis. Results: The mean±Standard Deviation (SD) age of the patients was 34.8±14 years, with a male-to-female ratio of 1.7:1. The mean±SD duration of the disease was 28.8±33.8 months (median: 12 months). Fifteen patients had mild disease activity, 52 had moderate activity, and eight had severe activity. The mean±SD Hb level among the patients was 11.1±2.0 g/dL. The mean±SD values for Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were 80.4±7.7 fL, 26.4±4.0 pg, and 32.1±2.5 g/dL, respectively. The mean±SD serum iron level and ferritin levels were 59.3±29.1 mcg/dL and 27.2±27.9 ng/mL, respectively. The mean±SD TfS was 14.3±10.8%, while the mean±SD TIBC was 337.1±80.5 mcg/dL. A total of 45 (60%) patients had anaemia, and 16 (21.3%) patients had iron deficiency without anaemia. Among those with anaemia, 32 (42.7%) had IDA and 13 (17.3%) had mixed anaemia; none of the patients had ACD. In total, 61 (81.3%) patients had iron deficiency, with or without anaemia. Hb, RBC indices and iron studies were comparable between both groups. Conclusion: Iron deficiency anaemia is common in UC patients, affecting 60% of the cohort; however, iron deficiency without anaemia was also observed in 21.3% of patients. Changes in Hb, RBC indices and iron studies were independent of disease activity.

Keywords

• disease severity
• inflammatory bowel disease
• iron deficiency